Medical abortion

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Medical Abortion (MA) is an abortion method using medication and has miscarriage-like reaction. Medical abortion can be self administered with the combination of Mifepristone and Misoprostol, or Misoprostol only if Mifepristone is not available.

Table 2.2 Medical Abortion Protocols for up to 9 weeks

Regiment Dosage Protocol
Mifepristone and Misoprostol 1 Mifepristone (200 mg) + 4 Misoprostol (@ 200 mcg) 1 Mifepristone administered orally. 24 hours later, 4 Misoprostol sublingually administered.
Only Misoprostol 12 Misoprostol

(@200 mcg)

4 Misoprostol administered sublingually. repeat every 3 hour with the same dosage up to maximum 12 pills.



  1. Ectopic Pregnancy. Before administering medical abortion, it is important to ensure whether you are having an ectopic pregnancy or not. Medical abortion is ineffective when administered during an ectopic pregnancy.
  2. The use of IUD. Before administering medical abortion, IUD has to be removed to avoid any injury within the uterus‘ lining.
  3. Allergies to Mifepristone and Misoprostol.
  4. Haemorrhage disorders or when simultaneously administered with anticoagulant therapy.

Aside from general contraindications, there are also specific contraindications  such as chronic adrenal gland failure, long term corticosteroid therapy and Porphyria indication (a rare hereditary blood disease).

How does mifepristone work?

Mifepristone ends a pregnancy by blocking the receptors of the hormone progesterone, causing the lining of the uterine walls to shed similar to during one’s menstrual cycle. It also increases prostaglandin levels and dilates the cervix, facilitating abortion.

Some women experience mild side effects such as; feeling tired, nausea, and headaches. Only a few who reported experiencing back pain, cramps, diarrhea, vomiting, and spotting. The side effects are pretty mild, also well tolerated by the body. Do not worry to maintain your normal daily activities. Mifepristone is safe to use during your activities.


How does Misoprostol work?

Misoprostol is a prostaglandin analog E1 (PGE1) synthesis that is usually used to prevent peptic ulcers and various obstetric indications such as safe abortion, induction of labor and handling of miscarriage.

The way misoprostol works like miscarriage is the basic idea of using misoprostol to terminate pregnancy. This genius idea was discovered decades ago by the women in Brazil – where abortion restricted by the law, and these women perform various trials with drugs that can lead to miscarriage.


Their experiment and findings eventually attracted researchers to develop research on misoprostol for safe abortion. And now, decades later we enjoy the results. Misoprostol is widely available and saves women’s lives. Misoprostol is available in pharmacies in almost all countries. and typically sold in pharmacies in tablets of 200 mcg. WHO has recommended the use of Misoprostol for safe abortion. To know more about WHO recommendation, you may check here.

Misoprostol causes contractions of the womb. As a consequence, the womb expels the pregnancy. In general, misoprostol will be effective within a period of 4 hours to 12 hours.  You may get painful cramps, vaginal blood loss that is more than a regular menstruation, nausea, vomiting, diarrhea, Fatigue, dizziness, headache, chills, fever, and shiver. You can use painkillers such as ibuprofen or paracetamol to relieve the pain. Blood loss is often heavy with clots. If the abortion is complete, the bleeding and the cramps diminish. Some women have allergies to misoprostol; itching, numbness or skin irritation on certain parts.

Bleeding starts after the first or second dose. But every woman has a different and unique body; therefore, misoprostol may react differently. Some women may experience bleeding the latest 12 hours after the first dose, but the case is very rare. If bleeding did not appear after 12 hours, please contact your counselor.

Do not use tampons, only use pads! Bleeding will last about two or three weeks, but there is the possibility of a shorter or longer. Your menstrual cycle returns to normal after 4-6 weeks.



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